Long-Term Headache and Cognitive Complaints Among Health Care Workers Who Acquired SARS-CoV-2.

Introduction Neurological manifestations are frequent after acquiring COVID-19 and may persist long-term as part of post-COVID-19 syndrome. Cognitive impairment, chronic fatigue, sleep disturbances, and headache complaints are the most reported neurological features. During the COVID-19 pandemic, health care workers were particularly vulnerable due to the high workload and levels of stress associated with this period, but acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may also contribute. The authors aimed to evaluate the neurological involvement of acquiring SARS-CoV-2 in a population of hospital health care workers and its impact on their personal and professional lives. Methods A sample of health care workers who did and did not acquire SARS-CoV-2 matched by age and sociodemographic variables was studied. Through an online questionnaire, data were collected regarding the symptoms in the acute phase of the disease (for those who acquired it) and for all in the last 6 months of the study period. Proportion of neurological complaints were compared between groups, adjusting for age, sex, and professional class (using a rate ratio (RR)). Results This study included 326 participants (174 cases and 152 controls). The mean age (standard deviation) was 39.7 (10.2) years, and the female:male ratio was 3:1. Headache and cognitive complaints were the most prevalent neurological complaints in the last 6 months of the study period. The health care workers who acquired SARS-CoV-2 were more likely to report headache and cognitive complaints than the control group (RR = 1.51, 95% confidence interval = 1.17-1.9 and RR = 2.02, 95% confidence interval = 1.53-2.65, respectively). Conclusion In a population of health care workers, those who acquired SARS-CoV-2 were more likely to have long-term cognitive complaints and persistent headaches.

Vascular White Matter Lesions in Young Adults: A Neurology Outpatient Clinic Registry.

INTRODUCTION: Although frequently assumed to be age-related changes, vascular white matter lesions (WML) are sometimes found in young adults. Etiology is usually attributed to sporadic small vessel disease; nevertheless, genetic disorders may also be implicated. We aimed to characterize the population of young adults with vascular WML in Neurology outpatient clinics. METHODS: Neurologists from 12 Portuguese hospitals were invited to include patients aged 18-55 years evaluated in consultation, with vascular WML on MRI, scoring II or III in the Fazekas scale. Central imaging validation was performed by 2 independent, blinded, Neuroradiologists. Demographic and clinical data were collected as well as results of investigations performed. RESULTS: During 2 years, 77 patients were included (mean age 47.7 years). Vascular risk factors were present in 88.3% patients (hypertension in 53.2%) and previous history of stroke in 36.4%. Patients without history of stroke were younger (46.6 ± 7.2 vs. 49.6 ± 3.9 years, p = 0.045) and had fewer vascular risk factors (p < 0.001). They were more frequently females (87.8 vs. 46.4%, p < 0.001), and headache (30.6 vs. 3.6%, p = 0.007), contrary to focal symptoms (16.3 vs. 53.6%, p = 0.001), was the most frequent reason of referral. Etiological investigations performed differed between Neurologists. A genetic disorder was identified in 6 out of 58 patients (CADASIL n = 5; COL4A1 n = 1). CONCLUSION: Young adults with vascular WML evaluated in Neurology outpatient clinics concentrate in the oldest age groups. Vascular risk factors should be screened carefully in this population. Among patients without history of stroke, females largely outweigh males. Diagnostic investigations performed do not follow a standardized protocol.

Neurobrucellosis and venous sinus thrombosis: an uncommon association.

Brucellosis is a commonly diagnosed zoonosis and neurological involvement is rare. A 30-year-old woman presented with a pulsatile headache that was exacerbated by the Valsalva maneuver and refractory to analgesic therapy. The patient also had nausea, cough, and coryza that evolved over 7 days. The neurological examination was unremarkable. Thrombosis of the lateral and sigmoid sinus and ipsilateral internal jugular vein were diagnosed and anticoagulation therapy was started. Brucella spp was identified in a sample of cerebrospinal fluid (CSF); five months after treatment with rifampicin and doxycycline, CSF was sterile. Cerebral venous thrombosis is a very uncommon sign of brucellosis.

Neurobrucellosis and venous sinus thrombosis: an uncommon association

Abstract: Brucellosis is a commonly diagnosed zoonosis and neurological involvement is rare. A 30-year-old woman presented with a pulsatile headache that was exacerbated by the Valsalva maneuver and refractory to analgesic therapy. The patient also had nausea, cough, and coryza that evolved over 7 days. The neurological examination was unremarkable. Thrombosis of the lateral and sigmoid sinus and ipsilateral internal jugular vein were diagnosed and anticoagulation therapy was started. Brucella spp was identified in a sample of cerebrospinal fluid (CSF); five months after treatment with rifampicin and doxycycline, CSF was sterile. Cerebral venous thrombosis is a very uncommon sign of brucellosis.

Epidemiology of myasthenia gravis in Northern Portugal: Frequency estimates and clinical epidemiological distribution of cases.

INTRODUCTION: In this study we estimated the prevalence, incidence, and mortality of myasthenia gravis (MG) in northern Portugal and characterized the clinical features of the patients identified. METHODS: We used 2 data sources: clinical records from the hospitals and pyridostigmine prescription registers. RESULTS: On December 31, 2013, we estimated a point prevalence of 111.7 patients per million population. The highest prevalence was observed in the group >65 years of age, especially in men (288.1 per million). During 2013, we estimated an incidence rate of 6.3 per million per year. Among women, the incidence rate was highest in the 15-49-year age group; in men, incidence increased with age up to 22.1 per million in those >65 years old. The MG-related mortality rate was 0.5 per million. CONCLUSIONS: These figures are in keeping with similar studies and emphasize the importance of diagnosis and management of MG in elderly populations. Muscle Nerve 54: 413-421, 2016.

Hansen Neuropathy: Still a Possible Diagnosis in the Investigation of a Peripheral Neuropathy.

INTRODUCTION: Leprosy is still one of the most frequent causes of peripheral neuropathy. Although regarded as eradicated in Portugal, is still documented in neuropathological study of patients with clinical peripheral neuropathy without proper diagnosis. MATERIAL AND METHODS: Review of the cases of Hansen disease neuropathy diagnosed in Neuropathology Unit of Centro Hospitalar do Porto between 1978 and 2013, atending to gender, age, clinical manifestations and neuropathological findings. RESULTS: Twenty one patients were identified with neuropathological diagnosis of Hansenâs disease neuropathy, predominantly male. The mean age at diagnosis was 52 years, and sensory symptoms predominate as neurological manifestation of disease. Interval between symptoms and diagnosis was 1-38 years. In most nerve samples tuberculoid type of disease was identified. Bacilli were detected in skin and nerve in 44% of cases. DISCUSSION: Mononeuritis is the most common presentation of leprosy but other clinical manifestations are possible, including skin lesions. Infection with M. leprae injures myelinated and unmyelinated fibres, with replacement of nerve tissue by collagen fibrosis. The diagnosis of leprosy is only achieved by neuropathological study of skin lesions and / or peripheral nerve, supported by the identification of the bacillus. CONCLUSION: Hansen disease remains a public health problem in tropical areas and, although rare, still described in Western countries reason why should still be considered as a diagnostic possibility in the investigation of peripheral neuropathy.

Introdução: A lepra continua a ser uma das causas mais frequentes de neuropatia periférica. Apesar de tida como erradicada em Portugal, ainda se documenta no estudo neuropatológico de doentes com clínica de neuropatia periférica sem diagnóstico etiológico definido.Material e Métodos: Revisão dos casos neuropatia por doença de Hansen diagnosticados na Unidade de Neuropatologia do Centro Hospitalar do Porto no período de 1978 e 2013 atendendo ao género, idade, manifestações clínicas e achados neuropatológicos.Resultados: Foram identificados 21 doentes com diagnóstico neuropatológico de neuropatia por doença de Hansen, com predomínio do sexo masculino. A idade média ao diagnóstico foi de 52 anos, sendo a sintomatologia sensitiva predominante. O intervalo entre sintomatologia e diagnóstico oscilou entre 1 a 38 anos. Na maioria foi identificada forma tuberculoide em biópsia de nervo e detetados bacilos em pele e nervo em 44% dos casos.Discussão: A mononeurite é a forma mais comum de apresentação de hanseníase, podendo cursar com outras manifestações clínicas incluindo lesões cutâneas. A infeção pelo M. leprae lesiona fibras mielinizadas e não mielinizadas, com substituição do tecido nervoso por colagénio resultando em fibrose. O diagnóstico da lepra é apenas conseguido por estudo neuropatológico das lesões cutâneas e/ou nervo periférico, adjuvado pela identificação do bacilo.Conclusão: A doença de Hansen continua a ser um problema de saúde pública em áreas tropicais e, apesar de rara, ainda descrita em países ocidentais, devendo ser considerada como uma hipótese de diagnóstico na investigação de neuropatia periférica.

Brain Abscess due to Staphylococcus lugdunensis in the Absence of Endocarditis or Bacteremia.

Staphylococcus lugdunensis has been recognized to be a microorganism potentially more virulent than other coagulase-negative staphylococci. We report the case of a patient who presented with a single, large, right, frontoparietal abscess that evolved despite conventional antibiotic treatment. Bacteremia and endocarditis were excluded. After surgical treatment, S. lugdunensis sensible to trimethoprim-sulfamethoxazole was isolated, and the patient responded favorably to treatment. Although the ability of S. lugdunensis to produce brain abscesses has been recognized, we report a case of a brain abscess in the absence of bacteremia or endocarditis.

Multiple sclerosis and motherhood choice: an observational study in Portuguese women patients.

INTRODUCTION. Multiple sclerosis (MS) is a disabling disease occurring mainly in women of childbearing age. MS may interfere with family planning and motherhood decision. AIM. To study the influence of MS diagnosis and course of the disease on motherhood decision. PATIENTS AND METHODS. The cohort of 35 to 45-year-old female patients diagnosed with MS for at least ten years was selected from six Portuguese MS centers. A structured questionnaire was applied to all patients in consecutive consultation days. Clinical records were reviewed to characterize and collect information about the disease and pregnancies. RESULTS. One hundred women were included; mean age at MS diagnosis was 26.3 ± 5.0 years; 90% of the participants presented with a relapsing-remitting MS; 57% had no pregnancies after the diagnosis. MS type and number of relapses were not significantly different between women with or without pregnancies after the diagnosis (p = 0.39 and p = 0.50, respectively). Seventy-seven percent of the patients did not have the intended number of pregnancies. Main reasons given were fear of future disability and the possibility of having relapses. Forty-three women considered that pregnancy might worsen MS. CONCLUSION. In our population, motherhood choice was unrelated to the MS type and the number of relapses. However, a relevant number of women had fewer pregnancies than those intended before MS diagnosis and believed that pregnancy could worsen the disease. An effort to better inform the patients should be made to minimize the impact of MS diagnosis on motherhood decision.

TITLE: Esclerosis multiple y decision de la maternidad: estudio observacional en pacientes portuguesas.Introduccion. La esclerosis multiple (EM) es una enfermedad incapacitante que afecta mayoritariamente a mujeres en edad fertil. La EM puede alterar el deseo de crear una familia y concebir hijos. Objetivo. Estudiar la influencia del diagnostico de la EM y de su evolucion sobre la decision de ser madre. Pacientes y metodos. Se selecciono una cohorte integrada por pacientes de 35-45 años diagnosticadas de EM desde hacia por lo menos 10 años que eran atendidas en seis centros portugueses. Las participantes respondieron a un cuestionario estructurado en dias de consulta consecutivos. Se revisaron las historias clinicas para caracterizar y recabar informacion sobre la enfermedad y los embarazos. Resultados. Participaron 100 mujeres; la media de edad en el momento del diagnostico de la EM era de 26,3 ± 5,0 años; el 90% de las participantes presentaba la forma remitente recurrente; el 57% de las pacientes no se habian quedado embarazadas despues del diagnostico. El tipo de EM y el numero de recidivas no difirieron de manera significativa entre las mujeres que habian concebido despues del diagnostico y las que no (p = 0,39 y p = 0,50, respectivamente). El 77% no habia tenido el numero de hijos deseado. Los principales motivos aducidos fueron el temor a la incapacidad futura y la posibilidad de sufrir recidivas. Cuarenta y tres mujeres creian que el embarazo podia agravar la EM. Conclusion. En la poblacion del estudio, la decision de ser o no ser madre no guardo relacion con el tipo de EM ni con el numero de recidivas. No obstante, un numero relevante de mujeres tuvieron menos embarazos de los que habian deseado antes de ser diagnosticadas y pensaban que la gestacion podia empeorar la enfermedad. Seria conveniente mejorar la informacion que reciben estas pacientes a fin de minimizar el impacto del diagnostico de la EM en la decision de ser madre.

Esclerosis múltiple y decisión de la maternidad: estudio observacional en pacientes portuguesas / Multiple sclerosis and motherhood choice: an observational study in Portuguese women patients

Introducción. La esclerosis múltiple (EM) es una enfermedad incapacitante que afecta mayoritariamente a mujeres en edad fértil. La EM puede alterar el deseo de crear una familia y concebir hijos. Objetivo. Estudiar la influencia del diagnóstico de la EM y de su evolución sobre la decisión de ser madre. Pacientes y métodos. Se seleccionó una cohorte integrada por pacientes de 35-45 años diagnosticadas de EM desde hacía por lo menos 10 años que eran atendidas en seis centros portugueses. Las participantes respondieron a un cuestionario estructurado en días de consulta consecutivos. Se revisaron las historias clínicas para caracterizar y recabar información sobre la enfermedad y los embarazos. Resultados. Participaron 100 mujeres; la media de edad en el momento del diagnóstico de la EM era de 26,3 ± 5,0 años; el 90% de las participantes presentaba la forma remitente recurrente; el 57% de las pacientes no se habían quedado embarazadas después del diagnóstico. El tipo de EM y el número de recidivas no difirieron de manera significativa entre las mujeres que habían concebido después del diagnóstico y las que no (p = 0,39 y p = 0,50, respectivamente). El 77% no había tenido el número de hijos deseado. Los principales motivos aducidos fueron el temor a la incapacidad futura y la posibilidad de sufrir recidivas. Cuarenta y tres mujeres creían que el embarazo podía agravar la EM. Conclusión. En la población del estudio, la decisión de ser o no ser madre no guardó relación con el tipo de EM ni con el número de recidivas. No obstante, un número relevante de mujeres tuvieron menos embarazos de los que habían deseado antes de ser diagnosticadas y pensaban que la gestación podía empeorar la enfermedad. Sería conveniente mejorar la información que reciben estas pacientes a fin de minimizar el impacto del diagnóstico de la EM en la decisión de ser madre (AU)

Introduction. Multiple sclerosis (MS) is a disabling disease occurring mainly in women of childbearing age. MS may interfere with family planning and motherhood decision. Aim. To study the influence of MS diagnosis and course of the disease on motherhood decision. Patients and methods. The cohort of 35 to 45-year-old female patients diagnosed with MS for at least ten years was selected from six Portuguese MS centers. A structured questionnaire was applied to all patients in consecutive consultation days. Clinical records were reviewed to characterize and collect information about the disease and pregnancies. Results. One hundred women were included; mean age at MS diagnosis was 26.3 ± 5.0 years; 90% of the participants presented with a relapsing-remitting MS; 57% had no pregnancies after the diagnosis. MS type and number of relapses were not significantly different between women with or without pregnancies after the diagnosis (p = 0.39 and p = 0.50, respectively). Seventy-seven percent of the patients did not have the intended number of pregnancies. Main reasons given were fear of future disability and the possibility of having relapses. Forty-three women considered that pregnancy might worsen MS. Conclusion. In our population, motherhood choice was unrelated to the MS type and the number of relapses. However, a relevant number of women had fewer pregnancies than those intended before MS diagnosis and believed that pregnancy could worsen the disease. An effort to better inform the patients should be made to minimize the impact of MS diagnosis on motherhood decision (AU)

Aspectos históricos, fisiológicos e antroposóficos do leite na alimentação humana: uma introdução ao tema / Historic, physiologic and anthroposophic aspects of milk in human nutrition: an introduction to the issue

O leite de vaca é um alimento amplamente consumido pelas populações humanas de todo o mundo há milhares de anos e o leite humano é o alimento fundamental para o desenvolvimento saudável da criança. A literatura científica tem dado grande destaque ao estudo desses alimentos e apontado muitas contradições nos resultados no que tange a relação favorável ou desfavorável do leite de vaca no desenvolvimento de doenças crônicas. O tema foi abordado por Rudolf Steiner em algumas conferências médicas em que estabeleceu correlações do ponto de vista da ciência antroposófica. O artigo descreve os resultados iniciais de uma pesquisa sobre o leite em três fontes: na literatura geral, na literatura acadêmica e na literatura antroposófica com o objetivo de alcançar uma compreensão ampliada do assunto considerando várias fontes de informação.(AU)

Cow's milk is widely consumed by human populations around the world for thousands of years and human milk is considered essential food for healthy child development. The scientific literature has given great emphasis to their study and pointed out many contradictions in the results related to cow's milk favorable or unfavorable role to the development of chronic diseases. The topic was addressed by Rudolf Steiner in some medical conferences that established correlations from the point of view of anthroposophic science. This paper describes the initial results of a research about milk in three sources: general, academic and anthroposophic literature with the objective of achieving a broader understanding about the issue considering all sources.(AU)

Problemas de saúde e riscos ocupacionais: percepções dos trabalhadores de enfermagem de unidade materna infantil / Health Problems and Occupational Risks in Hospital: nursing workers’ perceptions

Pesquisa quantitativa, descritiva, com 53 trabalhadores de enfermagem de uma unidade hospitalar federal do Rio de Janeiro. Teve como objetivo analisar a percepção dos trabalhadores de enfermagem sobre suas condições de trabalho, riscos ocupacionais e problemas de saúde em uma unidade materno-infantil. A coleta de dados ocorreu de fevereiro a agosto de 2007, utilizando-se questionários aplicados a trabalhadores e gerência do serviço de enfermagem. Evidenciou-se que os trabalhadores de enfermagem são em sua maioria do sexo feminino, com dupla ou tripla jornada de trabalho,causando redução do convívio familiar e da prática de bons hábitos de saúde. Na sua percepção, o trabalho é penoso, o ambiente os expõe a fatores de risco e condições inadequadas de trabalho, o que pode provocar ou agravar problemas de saúde já existentes. Sugeriu-se a aplicação de medidas para minimizar e/ou eliminar os riscos já existentes e melhorar as condições de trabalho.

Descriptive quantitative study with 53 nursing workers at a Federal Hospital Unit in Rio de Janeiro. Its aims were: to analyze nursing workers’ perceptions of their working conditions, occupational hazards and health problems in a Mother-Infant Unit. Data collection took place from February to August 2007, through questionnaires applied to nursing workers and Nursing Service Management. It became evident that nurses are mostly women who work double or triple shifts, which reduces family time and good health habits. They perceive the work as distressing and the workplace as exposing them to risk factors and inappropriate working conditions which may induce health problems or aggravate existing ones. This study suggested measures to minimize and/or eliminate existing risks and to improve working conditions.

Investigación cuantitativa, descriptiva, con 53 trabajadores de enfermería em una unidad hospitalaria federal de Rio de Janeiro - Brasil. Tuvo como objetivo analizar la percepción de los trabajadores de enfermería sobre sus condiciones de trabajo, riesgos laborales y problemas de salud en una unidad materno-infantil. La recolección de datos acaeció de febrero a agosto de 2007, a través de cuestionarios aplicados a trabajadores de enfermería y a la gestión del servicio de enfermería. Se hizo evidente que los enfermeros son en su mayoría mujeres, con doble o triple jornada de trabajo, lo que causa reducción del tiempo para la familia y para la práctica de buenos hábitos de salud. Ellos perciben el trabajo como penoso, el lugar de trabajo expone a factores de riesgo y a condiciones inadecuadas de trabajo, lo que puede inducir o agraviar los actuales problemas de salud. Esta investigación sugiere la aplicación de medidas para minimizar y/o eliminar los riesgos ya existentes y para mejorar las condiciones de trabajo.

Condições de trabalho, fatores de risco e problemas de saúde percebidos pelo trabalhador de enfermagem hospitalar / Working conditions, risk factors and health problems perceived by hospital nursing workers

Pesquisa quantitativa, descritiva, com 53 trabalhadores de enfermagem de uma Unidade Hospitalar Federal do Rio de Janeiro. Tem como objetivo geral: analisar a percepção dos trabalhadores de enfermagem em uma Unidade Materno-Infantil sobre suas condições de trabalho, riscos ocupacionais e problemas de saúde, através dos objetivos específicos: (1) descrever as condições de trabalho da Unidade em estudo; (2) levantar os fatores relativos às condições de trabalho que possam expor os trabalhadores a riscos e ao adoecimento; (3) verificar se os trabalhadores consideram adequados às condições de trabalho à sua saúde. Para atender aos objetivos foram utilizados questionários aplicados com trabalhadores e gerência do Serviço. A coleta dos dados foi realizada entre maio e agosto de 2007. Os dados foram apurados através dos programas Windows e Excell, em banco de dados, com freqüência absoluta, relativa, e percentuais demonstrados em tabelas e gráficos. Evidenciou-se que os trabalhadores de enfermagem são, em sua maioria, do sexo feminino, de faixa etária jovem (20 a 39 anos), realizando dupla ou tripla jornada de trabalho, privando-se do convívio familiar e, de ter bons hábitos de saúde em função de tempo. Na sua percepção, o trabalho é penoso, o ambiente os expõe a fatores de risco e condições inadequadas que resultam em problemas de saúde e índices de absenteísmo elevado (35 porcento). Foram sugeridas medidas com objetivo de minimizar e/ou eliminar os riscos existentes, melhoria das condições de trabalho, de modo a contribuir para a saúde destes trabalhadores de enfermagem...

Descriptive quantitative research with 53 nursing workers at a Federal Hospital Unit in Rio de Janeiro. Its main aim: to analyze the nursing workers’ perception of their working conditions, occupational hazards and health problems, through specific objectives: (1) to describe the working conditions of the analyzed Unit; (2) to assess the factors related to the working conditions that may expose the workers to risks and to their sickening; (3) to check if the workers consider the working conditions adequate to their health. In order to suit the objectives, questionnaires were applied to the workers and to the management of the service. The assessment of the data was fulfilled from May to August 207. The data were analyzed using the operational system Microsoft Windows and the software Microsoft Excel, in a data bank, with absolute, relative and perceptual frequency presented in charts and graphics. It became evident that the nursing workers are mostly women, of young age (from 20 to 39 years old), working double or triple working shifts, depriving themselves from family life, and from having good health habits due to lack of time. They feel work is troublesome, that the working place exposes them to risk factors and inadequate conditions that result in health problems and high absenteeism index (35 percent). Measures to minimize and/or eliminate the existing risks and to improve the working conditions were suggested in order to contribute to the health of these nursing workers...